Provider Demographics
NPI:1518293513
Name:MERCADO, KRISTY ANNE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:ANNE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 COLUSA AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-1517
Mailing Address - Country:US
Mailing Address - Phone:510-421-4745
Mailing Address - Fax:
Practice Address - Street 1:565 WINE ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-4054
Practice Address - Country:US
Practice Address - Phone:510-231-1417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124498106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist